Abstract: Objective To analyze the effect of etomidate combined with low dose esketamine in anesthesia induction in the elderly patients undergoing total hip replacement. Methods A total of 85 elderly patients who underwent total hip arthroplasty at Affiliated Nantong Hospital Of Shanghai University (The Sixth People’s Hospital of Nantong) from April 2021 to March 2024 were prospectively selected. According to the anesthesia methods, they were divided into an observation group (44 cases, receiving etomidate 0.2 mg/kg, sufentanil 0.4 μg/kg, and esketamine 0.2 mg/kg during anesthesia induction) and a control group (41 cases, receiving etomidate 0.2 mg/kg, sufentanil 0.4 μg/kg, and an equal volume of normal saline instead of esketamine during anesthesia induction). The hemodynamics, blood pressure levels, postoperative pain degrees, adverse reactions and complications during anesthesia induction were compared between the two groups. Results At the time of 3 minutes (T1) and 5 minutes (T2) after anesthesia induction, the mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in both groups were significantly lower than those before anesthesia induction (P<0.05), but the levels of these indicators in the observation group were higher than those in the control group (P<0.05). At T2, the levels of MAP, HR, SBP and DBP in both groups increased significantly compared to those at T1 (P<0.05). The Visual Analogue Scale (VAS) scores 12 and 24 hours after operation were significantly lower than those 2 hours after operation in both groups (P<0.05). Twenty-four hours after operation, the VAS scores of both groups were lower than those 12 hours after operation(P<0.05). The VAS scores of the observation group 2, 12, and 24 hours after operation were lower than those of the control group (P<0.05). There were no differences in the incidence rates of hypertension, tachycardia, muscle spasm and bradycardia between the two groups (P>0.05), and the incidence rates of hypotension and cough in the observation group were lower than those in the control group (P<0.05). Conclusions Etomidate combined with low-dose esketamine has a definite analgesic effect in elderly patients undergoing total hip replacement, which can reduce postoperative pain, maintain stable intraoperative hemodynamics, stable blood pressure, and reduce the risk of cough and hypotension.    

Key words: etomidate, esketamine, aged, total hip arthroplasty, hemodynamics